Individual
STEVEN A CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CACIII
Contact information
Practice address
8745 COUNTY ROAD 9 S, ALAMOSA, CO 81101-9610
(719) 589-3671
(719) 587-5693
Mailing address
193 EDGEMONT BLVD, ALAMOSA, CO 81101-2345
(719) 589-4090
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1851
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1851
CACIII
CO
Enumeration date
03/15/2007
Last updated
07/08/2007
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